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Titolo:
Aspirin for the primary prevention of stroke and other major vascular events - Meta-analysis and hypotheses
Autore:
Hart, RG; Halperin, JL; McBride, R; Benavente, O; Man-Son-Hing, M; Kronmal, RA;
Indirizzi:
Univ Texas, Hlth Sci Ctr, Dept Med Neurol, San Antonio, TX 78284 USA Univ Texas San Antonio TX USA 78284 Med Neurol, San Antonio, TX 78284 USA Mt Sinai Med Ctr, Cardiovasc Inst, New York, NY 10029 USA Mt Sinai Med Ctr New York NY USA 10029 ovasc Inst, New York, NY 10029 USA Stat Epidemiol Res Corp, Seattle, WA USA Stat Epidemiol Res Corp Seattle WA USA idemiol Res Corp, Seattle, WA USA Univ Ottawa, Div Geriatr Med, Ottawa, ON, Canada Univ Ottawa Ottawa ON Canada Ottawa, Div Geriatr Med, Ottawa, ON, Canada Univ Washington, Dept Biostat, Seattle, WA 98195 USA Univ Washington Seattle WA USA 98195 Dept Biostat, Seattle, WA 98195 USA
Titolo Testata:
ARCHIVES OF NEUROLOGY
fascicolo: 3, volume: 57, anno: 2000,
pagine: 326 - 332
SICI:
0003-9942(200003)57:3<326:AFTPPO>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; LOW-DOSE ASPIRIN; MYOCARDIAL-INFARCTION; CARDIOVASCULAR HEALTH; SECONDARY PREVENTION; ACETYLSALICYLIC-ACID; PHYSICIANS HEALTH; RANDOMIZED TRIAL; BLOOD-PRESSURE; RISK;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
42
Recensione:
Indirizzi per estratti:
Indirizzo: Hart, RG Univ Texas, Hlth Sci Ctr, Dept Med Neurol, 7703 Floyd Curl Dr, San Antonio, TX 78284 USA Univ Texas 7703 Floyd Curl Dr San Antonio TX USA 78284 78284 USA
Citazione:
R.G. Hart et al., "Aspirin for the primary prevention of stroke and other major vascular events - Meta-analysis and hypotheses", ARCH NEUROL, 57(3), 2000, pp. 326-332

Abstract

Background: Aspirin therapy reduces stroke by about 25% fbr persons with atherosclerotic vascular disease, but the effect in those without clinicallyapparent vascular disease is distinctly different. Objective: To define the effect of aspirin use on stroke and other major vascular events when given for primary prevention to persons without clinically recognized vascular disease. Data Sources and Extraction: Systematic review of randomized clinical trials and large prospective observational cohort studies examining the relation between aspirin use and stroke in persons at low intrinsic risk. Studies were identified by a computerized search of the English-language literature. Data Synthesis: Five randomized trials of primary prevention included 52 251 participants randomized to aspirin doses ranging from 75 to 650 mg/d; the mean overall stroke rate was 0.3% per year during an average follow-up of4.6 years. Meta-analysis revealed no significant effect on stroke (relative risk = 1.08, 95% confidence interval, 0.95-1.24) contrasting with a decrease in myocardial infarction (relative risk = 0.74, 95% confidence interval, 0.68-0.82). The lack of reduction of stroke by aspirin for primary prevention was incompatible with its protective effect against stroke in patientswith manifest vascular disease (P = .001). Intracranial hemorrhage was increased by the regular use of aspirin (relative risk = 1.35: P = .03), similarly for both primary and secondary prevention. III 4 large observational studies, self-selected use of aspirin was consistently associated with higher rates of stroke. Conclusions: The effect of aspirin therapy on stroke differs between individuals based on the presence or absence of overt vascular disease, in contrast with the consistent reduction in myocardial infarction by aspirin therapy observed in all populations. We hypothesize that the effect of aspirin therapy on stroke for persons with major risk factors for vascular disease may be intermediate between a substantial decrease for those with manifest vascular disease and a possible small increase fur healthy persons due to accentuated intracranial hemorrhage. When aspirin is given for primary prevention of vascular events, available data support using 75 to 81 mg/d.

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Documento generato il 30/11/20 alle ore 11:02:53